2. • What is tuberculous lymphadenitis ?
• Tuberculous lymphadenitis is also know as scrofula or king’s evil
Etiology : Mycobacterium tuberculosis
It is the most common site of extrapulmonary TB .
3. • Commonest site to be affected is the lymph nodes of the neck
• Out of these jugulodigastric is usually infected
• Second most common is the posterior cervical group
4. MODE OF SPREAD OF INFECTION
1) Through tonsils (Adenoids also)
2) Occasionally through blood
3) Rarely through sibsons fascia from apex of lung
6. • There are mainly 2 types
1) Caseating type (80%)
2) Hyperplastic type (15%)
7. Clinical presentation :
Depends on the stage in which the patient presents ; the various symptoms that can be present are
1)Swelling in the neck that is firm , matted
2) Cold abscess – Smooth ,fluctuant, non tender , not involving the skin
3)Collar stud abscess – Adherent to the underlying skin
4) Discharging sinus
Other associated presentations :
Tonsils studded with tubercles
Involvement of axillary , inguinal lymph nodes
Scrofuloderma- Bluish hyperpigmentation of skin
Cold abscess in spine
8. • Differential diagnosis
• Non specific lymphadenitis
• Lymphoma
• Metastatic secondaries
• Brachial cyst
9. Investigations
General investigations :
CBC,ESR , peripheral smear
Specific investiations
1)Ultrasound neck
Shows node size ,matting ,cold abscess ,track , number of nodes
2)FNAC
Epitheloid cells are diagnostic
3)Open node biopsy ( When FNAC is inconclusive )
Other tests :
Hiv testing , cd4 counts , wbc counts
Chest Xray
Ct neck and chest to study nodal status
10. • Treatment
Anti Tubercular drugs – HRZE for 6 to 9 months
1)If cold abscess present : Aspiration – non dependent – z track
2)If it recurs – Incision and drainage
3)If persistent –surgical removal
Indications : 1. There is no local response to drugs
2. when sinus persists
4) Excision of sinus tract
